Patient's Query
Hello doctor,
My 40-year-old friend died of an accidental drug overdose, and I am struggling to understand how this could have happened. He had struggled with prescription drug addiction for several years, but I never believed it would lead to his death at such a young age. Can you explain the physiological mechanisms behind opioid overdose and why these medicines are particularly dangerous in high doses? I have heard it is related to respiratory depression, but I am not sure about the specifics. What are the precise effects of opioids on the brain and body that cause respiration to slow or stop abruptly?
Kindly check
Hello,
Welcome to icliniq.com.
I can understand your concern
Opioid use disorder (OUD) is a worldwide problem, and opioid overdose deaths are common.
Opioid intoxication is a clinical diagnosis. Depressed mental state, decreased respiratory rate, decreased tidal volume, decreased bowel sounds, and miotic pupils are all classic indications. A respiratory rate of less than 12 breaths per minute is the most accurate indicator of opioid poisoning. Normal pupil examination does not rule out opioid poisoning. In addition to suppressing respiratory rate, opioid poisoning can cause hypothermia, coma, seizures, head trauma, aspiration pneumonia, and rhabdomyolysis. Activation of opioid receptors inhibits synaptic neurotransmission in both the central and peripheral nervous systems. Opioids bind to and increase neurotransmission via three types of opioid receptors. Several poorly defined
The physiological effects of opioids are mediated principally through mu and kappa receptors in the central nervous system and periphery. Mu receptor effects include analgesia, euphoria, respiratory depression, and miosis. Kappa receptor effects include analgesia, miosis, respiratory depression, and sedation. Common classifications divide opioids into agonist, partial agonist, or agonist-antagonist agents and natural, semisynthetic, or synthetic. Opioids decrease the perception of pain, rather than eliminate or reduce the painful stimulus. Inducing slight euphoria, opioid agonists reduce the sensitivity to exogenous stimuli. The gastrointestinal tract and the respiratory mucosa provide easy absorption for most opioids. Peak effects generally are reached in ten minutes with the intravenous route, ten to fifteen minutes after nasal insufflation (eg, butorphanol, heroin), 30 to 45 minutes with the intramuscular route, 90 minutes with the oral route, and two to four hours after dermal application (ie, fentanyl). Following therapeutic oral doses, most absorption occurs in the small intestine. Toxic doses may have delayed absorption because of delayed gastric emptying and slowed gut motility.
Take care.
Thank you.
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Answered byDr. Shweta Dhawan
Medically reviewed byDr. Sowmiya D
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